Symptoms of Supraventricular Tachycardia
Palpitations are the hallmark symptom of SVT, occurring in 22% to 86% of patients, typically presenting as sudden-onset, rapid, regular heartbeats that start and stop abruptly. 1
Primary Symptoms
Palpitations and Heart Sensations:
- Sudden onset of rapid, regular palpitations that terminate abruptly (paroxysmal pattern) 2
- "Neck pounding" or "shirt flapping" sensations are highly specific for AVNRT, caused by atrial contraction against a closed tricuspid valve (cannon a-waves) 2, 1
- Heart rates typically range from 110-250 bpm, most commonly 180-200 bpm 2
Neurological Symptoms:
- Lightheadedness and dizziness are common complaints 3, 4
- True syncope occurs in approximately 4-15% of patients, usually immediately after SVT onset or following prolonged pause after termination 2, 1
- Elderly patients with AVNRT are more prone to syncope despite generally slower heart rates 2
Cardiopulmonary Symptoms:
- Chest pain or discomfort occurs in 5-47% of patients, resulting from myocardial ischemia due to increased oxygen demand 1, 5
- Shortness of breath (dyspnea) affects 38% of patients 3
- Fatigue is frequently reported 4
Other Characteristic Symptoms:
- Polyuria (excessive urination) is particularly common with AVNRT, caused by release of atrial natriuretic peptide from elevated atrial pressures 2, 1
- Anxiety symptoms, though 54% of patients are misdiagnosed with panic or anxiety disorders 1
Clinical Presentation Patterns
Temporal Characteristics:
- Episodes have abrupt onset and termination (distinguishing feature from sinus tachycardia, which accelerates and decelerates gradually) 2
- Symptoms may terminate spontaneously before medical evaluation 6
- Episodes often increase in frequency and severity over time 6
Age and Gender Patterns:
- Mean age of symptom onset: 32±18 years for AVNRT versus 23±14 years for AVRT in adults 2, 1
- AVNRT patients are more likely to be female with onset >30 years of age 2
- Overall, 67.5% of SVT patients are female 3
Serious Complications (Rare but Important)
Life-Threatening Presentations:
- Sudden cardiac death occurs in 0.2% of cases, particularly with Wolff-Parkinson-White syndrome 2, 1
- Syncope while driving occurs in 14% of patients who experience SVT episodes during driving 2, 1
- Tachycardia-mediated cardiomyopathy develops in approximately 1% when SVT persists for weeks to months with fast ventricular response 2, 3
Critical Diagnostic Pitfalls to Avoid
Common Misdiagnoses:
- 54% of SVT patients have symptoms incorrectly attributed to panic, anxiety, or stress, with women more likely than men to receive this misdiagnosis 1, 5
- Diagnosis is often delayed due to misattribution to anxiety disorders 7
- Episodes may terminate before presentation, leading to dismissal of symptoms 6
Key Distinguishing Features:
- Termination by vagal maneuvers (Valsalva, carotid massage) strongly suggests reentrant tachycardia involving AV nodal tissue 2
- Irregular palpitations suggest alternative diagnoses (premature beats, atrial fibrillation, or multifocal atrial tachycardia) rather than typical SVT 2
Impact on Daily Life
Functional Limitations:
- 57% of patients experience SVT episodes while driving 2, 1
- Among those with driving episodes: 77% experience fatigue, 50% have near-syncope, and 14% experience syncope 2, 1
- Quality of life impact varies with episode frequency, duration, and whether symptoms occur at rest versus only with exercise 2, 1